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OBJECTIVE: To explore whether self-determination and family socioeconomic status (SES) mediate and/or moderate the relationship between mobility and community participation of adolescents and young adults with cerebral palsy (CP). DESIGN: Survey. SETTING: Online platform. PARTICIPANTS: Of 55 eligible adolescents/young adults with CP, 50 agreed to participate and 2 were excluded. The final convenience sample included 48 individuals (N=48), aged 15-32 years, levels I-IV of the Gross Motor Function Classification System and I-II of the Communication Function Classification System. MAIN OUTCOME MEASURES: The Temple University Community Participation Measure documented the amount, breadth, and insufficiency/sufficiency ratios of participation across 26 community settings. The ARC Self-determination Scale and the Mobility Scale of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) measured individuals' self-determination (ie, autonomy, psychological empowerment, self-realization) and mobility skills, respectively. The Brazilian Economic Classification Criteria-2021 assessed family SES. RESULTS: Analyses of mediating/moderating effects revealed that the influence of individuals' mobility skills on their breadth of community participation was mediated by autonomy. Family SES moderated the indirect effect of mobility on community participation breadth through autonomy. When the model was adjusted for participants' age, individuals with higher SES reported greater breadth in community participation than those from moderate and lower SES for all mobility levels. However, the magnitude of the differences among individuals of different SES levels diminished as mobility increased. CONCLUSIONS: The mobility skills of youths with CP influence their community participation through autonomy. To foster greater engagement of these individuals in the community, rehabilitation professionals should focus not only on improvement of mobility skills but also on the promotion of self-determined behaviors, especially autonomy.

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OBJECTIVES: To describe and compare the incidence, prevalence, severity, and profile of injuries (acute and overuse) and illness between female and male youth elite judokas during 30 weeks of a sports season. DESIGN: Prospective cohort study. METHODS: A total of 154 elite youth judokas (83 males and 71 females) were assessed from January to August 2019 in a training period organized by the Brazilian Judo Confederation. We conducted a prospective 30-week follow-up study on acute and overuse injuries and illness among youth female and male judokas through the Oslo Sports Trauma Research Center questionnaire on health problems (OSTRC-H). Every week, the OSTRC-H was sent to all youth judokas electronically, starting in the first week of preseason. The incidence rate, prevalence, and severity of illnesses and acute and overuse injuries were compared between sexes using an independent t-test (variables with normal distribution) or Mann Whitney U test (variables with non-normal distribution) with α set a 0.05. RESULTS: Female and male judokas showed 16.96 and 16.57 injuries per 1000 athletic exposures, respectively (p = 0.383). Female judokas showed a higher average weekly prevalence of health problems (38.8%) than male judokas (29.0%). In addition, females had a greater prevalence of substantial health problems (p < 0.001), injuries (p < 0.001), and overuse injuries (p < 0.001) than males. CONCLUSION: There were no differences in the incidence rate of injuries between sexes. Youth female judokas showed a higher prevalence of all health problems than youth male judokas. For both sexes, the knee and shoulder were the most affected joints for acute and overuse injuries, respectively.

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DESIGN: Retrospective cohort study. OBJECTIVES: To investigate paid work status and return to work (RTW) pathways after spinal cord injury (SCI). SETTING: SARAH Network of Rehabilitation Hospitals. METHODS: Participants were adults with traumatic SCI, aged between 18 and 60 years at the time of the injury, admitted between 2000 and 2017. In the first stage, socio-demographic, injury-related, and functional status data were collected from medical records. In the second stage, data on paid work, means of mobility, driving ability, return to study, ability to work, and satisfaction with the work status were collected through an online survey conducted between January and March 2020. RESULTS: A total of 154 participants were included in the sample. Of these, 90% were working at the time of SCI and 23% were engaged in paid work at the time of the study. Three RTW pathways were identified among those who were working at the time of the injury and: did not return to work (78%); returned to a different occupation (12%) and returned to the same occupation (9%). Number of post-injury complications, returning to study, good work ability, and satisfaction with the work status were predictors of paid work. The model's adjusted coefficient was 56.5% (p = 0.001). CONCLUSION: Working-age people with SCI who underwent rehabilitation in Brazil had a low rate of paid work. Fewer complications at the time of the injury, returning to study, good ability to work and greater satisfaction with the work status increased the likelihood of being engaged in paid work.

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BACKGROUND: In Brazil, the number of physical therapy education programs and, consequently, of professionals has been growing for the past 20 years. OBJECTIVES: The objective of the study was to describe the evolution and distribution of physical therapist education programs in Brazil and to analyze the impact of workforce growth on the labor market for these professionals. DESIGN: This was a descriptive, exploratory, quantitative study. METHODS: Secondary data collected from official sources in Brazil were used. RESULTS: The first physical therapist education program was created in 1958, and, after significant growth, 536 programs were active in 2014. The historical series (1996-2014) shows a corresponding increase in the number of admissions by higher educational institutions. This expansion resulted in an increase in the number of professionals, with an impact on the labor market. The workforce in physical therapy is predominantly female, and women increased their participation in this labor market from 59% in 1996 to 81% in 2014. An increase in nominal monthly salaries was observed over the years from US $797.00 in 1996 to US $1056.00 in 2014. Nevertheless, the real average salaries, that is, salaries adjusted to inflation, have followed a trend of devaluation. LIMITATIONS: Results of this study must be interpreted in terms of overall trends rather than as precise absolute numbers due to the inherent nature of the varied secondary data sources. CONCLUSIONS: These data can support further discussion on training and the labor market in the field of physical therapy.

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ABSTRACT Background The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), developed with innovative measurement methodologies, evaluates functioning of children and youth, from 0 to 21 years, with different health conditions. It is a revision of an earlier instrument (PEDI) that has been used in national and international clinical practice and research. It was felt to be necessary to make this new version (PEDI-CAT) available in Brazil. Objectives Translate and culturally adapt the PEDI-CAT to the Brazilian-Portuguese language and test its psychometric properties. Method This methodological study was developed through the following stages: (1) translation, (2) synthesis, (3) back-translation, (4) revision by an expert committee, (5) testing of the pre-final version, and (6) evaluation of the psychometric properties. The 276 translated PEDI-CAT items were divided into three age groups (0-7, 8-14, and 15-21 years). Results The PEDI-CAT translation followed all six stages. The adaptations incorporated cultural and socioeconomic class specificities. The PEDI-CAT/Brazil showed good indices of inter-examiner (intraclass correlation coefficient-ICC=0.83-0.89) and test-retest (ICC=0.96-0.97) reliability, good internal consistency (0.99) and small standard error of measurement in all three age groups (0.12-0.17). Factor analyses grouped the items from the three functional skills domains into one factor, and items from the responsibility scale into three factors, supporting the adequacy of these factor solutions to the conceptual structure of the instrument and the developmental model. Conclusion The PEDI-CAT/Brazil is a theoretically consistent, culturally appropriate, and reliable instrument. Its availability in Brazil will contribute to the evaluation and measurement of functional outcomes from clinical interventions, longitudinal follow-up, and rehabilitation research.

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ABSTRACT Objective: To empirically test the relationships proposed by the International Classification of Functioning, Disability and Health (ICF) among its domains. Method: The cross-sectional study was completed with 226 adult patients with different health conditions who attended a Brazilian rehabilitation unit. The ICF components were measured with the following instruments: World Health Organization Disability Assessment Instrument II, Functional Independence Measure, Participation Scale, Craig Hospital Inventory of Environmental Factors, and a protocol designed to gather information on body structure and function and personal factors. Results: Structural equation modeling showed good model adjustment, GFI=0.863; AGFI=0.795; RMSEA=0.028 (90% CI=0.014-0.043). Significant relationships were found between activity and both body structure and function (standard coefficient=0.32; p<0.0001) and participation components (standard coefficient=–0.70; p<0.0001). Environmental and personal factors had a significant effect on the three functioning components (standard coefficient =0.39; p<0.0001; standard coefficient =-0.35; p<0.001, respectively). In contrast, body structure and function had no significant effect on participation (standard coefficient=–0.10; p=0.111) and health conditions had no significant effect on any of the functioning components, i.e., body structure and function, activity, and participation (standard coefficient=–0.12; p=0.128). Conclusion: Some of the ICF’s proposed relationships across domains were confirmed, while others were not found to be significant. Our results reinforce the contextual dependency of the functioning and disability processes, in addition to putting into perspective the impact of health conditions.

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BACKGROUND: Gait is an extremely complex motor task; therefore, gait data should encompass as many gait parameters as possible. OBJECTIVE: To provide reference values for gait measurements obtained from a Brazilian group of community-dwelling elderly females between the ages of 65 and 89 years and to apply the PCA-biplot to yield insight into different walking strategies that might occur during the aging process. METHOD: 305 elderly community-dwelling females living in Brazil were stratified into four age groups: 65-69 years (N=103); 70-74 years (N=95); 75-79 years (N=77); and ≥80 years (N=30). Age, height, and BMI were assessed to describe the characteristics of the groups. Gait spatiotemporal and variability data were obtained using the GAITRite® system. Principal component analysis, followed by MANOVA and the PCA-biplot approach were used to analyze the data. RESULTS: 95% CI showed that only three components - rhythm, variability, and support - together explained 74.2% of the total variance in gait that were different among the groups. The older groups (75-79 and ≥80 years) walked with lower than average velocity, cadence, and step length and were above average for the variables stance, step, swing, and double support time and the ≥80 year old group presented the highest gait variability compared to the other groups. CONCLUSION: Aging is associated with decreased gait velocity and cadence and increased stance, step time, and variability, but not associated with changes in base of support. In addition, the PCA-biplot indicates a decline towards decreased rhythm and increased variability with aging.

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BACKGROUND: The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), developed with innovative measurement methodologies, evaluates functioning of children and youth, from 0 to 21 years, with different health conditions. It is a revision of an earlier instrument (PEDI) that has been used in national and international clinical practice and research. It was felt to be necessary to make this new version (PEDI-CAT) available in Brazil. OBJECTIVES: Translate and culturally adapt the PEDI-CAT to the Brazilian-Portuguese language and test its psychometric properties. METHOD: This methodological study was developed through the following stages: (1) translation, (2) synthesis, (3) back-translation, (4) revision by an expert committee, (5) testing of the pre-final version, and (6) evaluation of the psychometric properties. The 276 translated PEDI-CAT items were divided into three age groups (0-7, 8-14, and 15-21 years). RESULTS: The PEDI-CAT translation followed all six stages. The adaptations incorporated cultural and socioeconomic class specificities. The PEDI-CAT/Brazil showed good indices of inter-examiner (intraclass correlation coefficient-ICC=0.83-0.89) and test-retest (ICC=0.96-0.97) reliability, good internal consistency (0.99) and small standard error of measurement in all three age groups (0.12-0.17). Factor analyses grouped the items from the three functional skills domains into one factor, and items from the responsibility scale into three factors, supporting the adequacy of these factor solutions to the conceptual structure of the instrument and the developmental model. CONCLUSION: The PEDI-CAT/Brazil is a theoretically consistent, culturally appropriate, and reliable instrument. Its availability in Brazil will contribute to the evaluation and measurement of functional outcomes from clinical interventions, longitudinal follow-up, and rehabilitation research.

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ABSTRACT Background Gait is an extremely complex motor task; therefore, gait data should encompass as many gait parameters as possible. Objective To provide reference values for gait measurements obtained from a Brazilian group of community-dwelling elderly females between the ages of 65 and 89 years and to apply the PCA-biplot to yield insight into different walking strategies that might occur during the aging process. Method 305 elderly community-dwelling females living in Brazil were stratified into four age groups: 65-69 years (N=103); 70-74 years (N=95); 75-79 years (N=77); and ≥80 years (N=30). Age, height, and BMI were assessed to describe the characteristics of the groups. Gait spatiotemporal and variability data were obtained using the GAITRite® system. Principal component analysis, followed by MANOVA and the PCA-biplot approach were used to analyze the data. Results 95% CI showed that only three components – rhythm, variability, and support - together explained 74.2% of the total variance in gait that were different among the groups. The older groups (75-79 and ≥80 years) walked with lower than average velocity, cadence, and step length and were above average for the variables stance, step, swing, and double support time and the ≥80 year old group presented the highest gait variability compared to the other groups. Conclusion Aging is associated with decreased gait velocity and cadence and increased stance, step time, and variability, but not associated with changes in base of support. In addition, the PCA-biplot indicates a decline towards decreased rhythm and increased variability with aging.

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